Background. Physical training should represent the primary therapeutic approach to prevent cardiovascular disease, overall in the subjects with metabolic syndrome (MetS). Few studies have been conducted to investigate the effects of spinning exercise on cardio-vascular weal. Despite this it has been emphasized that spinning puts strain on the cardiovascular system, questioning whether it can be recommended in the elderly. AIM. to assess whether a 6 months spinning training, combined with proper diet, is more effective than standard training programs and diet alone in improving metabolic abnormalities in elderly patients with MetS. DESIGN. Randomized clinical trial. SETTING. Rehabilitation Unit of the Department of Geriatric Sciences, Sapienza University of Rome POPULATION. elderly patients with MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) diagnostic criteria METHODS. Patients were randomly assigned to receive treatment with diet (group A, n = 10), with diet and general gymnastics program (group B, n = 10), with diet and spinning physical training program (group C, n = 10). The effects of interventions were assessed by differences in changes in components of MetS and associated biomarkers between the three groups. RESULTS. Thirty patient were recruited at this study and all completed the 6 months protocol. During the study period we observed a significant reduction in blood pressure (group C: systolic blood pressure p = 0.03; diastolic blood pressure p = 0.04 / group B: systolic blood pressure p = 0.001), in lipid profile (group B: plasma total cholesterl p < 0.0001; triglycerides p < 0.0001 / group C: plasma total cholesterol p = 0.04); in fasting blood glucose (group B: p = 0.01; group C: p = 0.008); in Homeostatic Model Assessment of Insulin Resistance (HOMA) (group B: p = 0.01; group C: p = 0.001); in waist circumference (group C: p = 0.005; group A: p = 0.022; group B: p = 0.037). CONCLUSION. Our results confirm the effectiveness of spinning physical training combined with diet in the management of MetS. CLINICAL REHABILITATION IMPACT. The findings provide a preliminary evidence to support that spinning training may represent a useful and safe intervention in geriatric patients with multiple CV risk factors. The working group and the presence of an instructor may lead to increase the adherence to physical exercise.